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| Idiopathic granulomatous mastitis - A diagnostic and therapeutic challenge: Report of three cases and literature review
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Z. Hayati, S. Jayi, L. Tahiri Ousrouti, H. Ismaili, Y. Belhaj, Fz. Fdili Alaoui, H. Chaara, Ma. Melhouf
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Abstract:
Idiopathic granulomatous mastitis (IGM) also referred to as nonpuerperal mastitis or granulomatous lobular mastitis, is a rare, benign, chronic, inflammatory disorder of the breast. Up to date, the exact aetiopathogenesis of IGM remains poorly understood. Patients typically present with painful breast mass, inflammation symptoms, abscess and fistula which can be confused with inflammatory breast cancer. IGM mimics breast malignancy not only clinically but also radiologically, the anatomopathological examination remains then the gold standard for positive and differential diagnosis. On the microscopic level, IGM presents as non-caseating granulomas and micro-abscess formation centred on the breast lobules. IGM is not only a diagnostic challenge, but also a therapeutic one since treatment is only symptomatic and not consensual. However, recent evidence suggests a superiority of medical treatment over surgical resections which are correlated to poor wound healing, high risk of recurrence and poor aesthetic outcomes. Oral, intra-lesional or topical corticosteroid therapy remains the first-line option for treating IGM. The aim of this paper is to remind clinicians of this entity which may imitate breast malignancy but remains a differential diagnosis, to review the current literature and take stock of the latest diagnostic and therapeutic progress in the subject and to contribute to the literature by reporting our cases.
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